As a result they overdo them, or don't pay attention to interactions with other medications," says Joseph Markenson, M.D., professor at Weill Medical College in New York City. "While the benefits of thee drugs are enormous and real, so too are the risks of gastrointestinal upset and bleeding.



With any OTC pain reliever, start low and go slow, says Dr. Fishman. He also suggests,"Don't use aspirin as your first choice for pain relief. It is short acting as far as pain goes, but long-acting in its impact on platelets and blood coagulation, and has a greater risk of causing ulcers than ibuprofen for example".

"You can protect yourself from ulcers related to NSAIDs," says Dr. Markenson. take them with an OTC or prescription proton pump inhibitor (PPI) or opt for a pure analgesic such as acetaminophen, which offer relief from headaches, muscle aches and fever, but does not cause bleeding.

Acetaminophen poses little threat when taken as recommended, but liver toxicity is a risk if you drink alcohol, have liver disease or are also taking an NSAID or any additional medication that contains aetaminophen.

And make sure you tell your pharmacist and doctor what prescription meds you take, especially phenobarbital, phenytoin (Dilantin), carbamazepine (Tegretol), rifampin (Rimactane, Rifadin), sulfinpyrazone (Anturane) and vitamin supplements. Surprised to find out that your "harmless" vitamin supplement can set off adverse reactions to medications? They can and plenty of research exists to prove that supplements can set off dangerous reactions when taken with OTC drugs.

"When it comes to decisions about pain relief", says Dr. Fishman, "you have to think about what makes sense for you and with individual risks and benefits. Is the pain affecting

your quality of life? Do you need a pain reliever to stay on track every day? Can you get rid of your headache for example some other way? Proceed cautiously".

And don't ignore pain, ever. It is trying to tell you something. The bottom line is to find out what the problem is and take corrective action before things get worse.